Association between cannabis and pain outcomes in a Tribally operated clinic

部落经营的诊所中大麻与疼痛结果之间的关联

• 批准号: 10460837
• 负责人: STACY M RASMUS
• 金额: $ 40万
• 依托单位: NORTHWEST INDIAN COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10460837
• 关键词: Adult; Affect; Age; Alaska Native; American Indians; Analgesics; Anti-Anxiety Agents; Anxiety; Arthritis; Cannabidiol; Cannabis; Caring; Clinic; Communities; Consultations; Data; Data Analyses; Data Collection; Diabetic Neuropathies; Discipline of Nursing; District of Columbia; Economic Factors; Elderly; Enrollment; Event; Female; Fibrinogen; Grant; Hemp; Individual; Industry; Institutional Review Boards; Interview; Legal; Life; Low Back Pain; Marijuana; Measures; Mediating; Medical; Medical Marijuana; Medicine; Mental Depression; Mental Health; Mentorship; Methods; Native American Research Center for Health; Native-Born; Pain; Pain Research; Pain intensity; Pain interference; Pain management; Participant; Patients; Pattern; Pharmacy facility; Pilot Projects; Post-Traumatic Stress Disorders; Poverty; Prevention; Procedures; Provider; Puyallup; Qualitative Methods; Race; Reporting; Research; Sampling; Science; Self Efficacy; Sleep; Sleep Disorders; Sleeplessness; Students; Tetrahydrocannabinol; Time; Training; Tribes; Universities; Washington; care seeking; chronic pain; chronic painful condition; clinical care; college; comorbidity; data infrastructure; data repository; demographics; experience; graduate student; healing; health care availability; improved; marijuana decriminalization; marijuana legalization; marijuana use; marijuana user; negative affect; nonmedical use; opioid misuse; opioid mortality; pain outcome; pain reduction; pain relief; prescription opioid; programs; sex; social factors; undergraduate student; vehicular accident

ABSTRACT American Indians and Alaska Native (AIAN) people are disproportionately affected by chronic pain conditions, including arthritis, diabetic neuropathy, and lower back pain. AIAN communities have also experienced harm as a result of pain solutions offered by Western medicine, such as prescription opioids, which have contributed to increased opioid misuse and mortality in AIAN people. Many AIAN people have turned to Native medicine and other non-Western approaches to pain management. Thirty-four states have legalized marijuana for medical use, while 12 states, and the District of Columbia, have legalized non-medical use, and cannabidiol (CBD) derived from hemp is no longer a controlled substance. Therefore, cannabis products are available to the majority of U.S. adults. 66% of adults think that cannabis provides pain relief, and 42% of medicinal marijuana users report using it to relieve pain. While initial evidence indicates that cannabis tetrahydrocannabinol [THC] has analgesic effects, the evidence for cannabis-associated reductions in pain intensity and interference (i.e., the extent to which pain interferes with functioning) is limited. There is very limited data about the effects of how a variety of cannabis products available on the legal market (e.g., different strains, methods of delivery) and patterns of use impact pain outcomes and the comorbidities (e.g., mental health, sleep) that are associated with pain. As a sovereign nation in Washington State, our Tribal partners developed the Qwibil Clinic, which advises patients on the use of cannabis for the management of pain and other medical problems. The Qwibil Clinic provides a unique opportunity to investigate the relationship between cannabis use, pain, and pain-related factors in an AIAN owned and operated clinic. We propose a mixed-methods embedded (QUANT+Qual) study to assess how cannabis impacts pain intensity and interference in a sample of n=350 patients seeking chronic pain treatment at the Qwibil Clinic. We will identify types and patterns of cannabis use that are associated with pain outcomes over 12-months of care. We will also determine whether the effect of cannabis on pain outcomes is mediated through known pain-related factors (i.e., negative affect, sleep problems, self-efficacy) over time. To supplement our quantitative methods, we will use qualitative interviews to explore how patients seeking care for pain experience cannabis and its impact on pain, including participants who differ by sex, race (AIAN, Non-AIAN), and type of cannabis used. Finally, we will provide opportunities for AIAN students enrolled in Washington State University medical, nursing, pharmacy, and prevention science graduate programs and Northwest Indian College undergraduate programs to receive training and mentorship in cannabis and pain research at the Qwibil Clinic, including training in qualitative and quantitative data collection and analysis and dissemination of research results. Results will provide important information about the impact of legal cannabis products on chronic pain in a mostly AIAN sample, providing important information to people with pain, providers, and Tribal policymakers.

抽象的 美国印第安人和阿拉斯加本地人（Aian）人受到慢性疼痛的影响不成比例 包括关节炎，糖尿病神经病和下背部疼痛在内的疾病。艾安社区也有 由于西方医学提供的疼痛解决方案，例如处方阿片类药物，遭受了伤害 助长了Aian人的阿片类药物滥用和死亡率的贡献。许多艾安人已经转向 本地医学和其他非西方疼痛管理方法。 34个州合法化 大麻用于医疗用途，而12个州和哥伦比亚特区已将非医学使用合法化，并且 源自大麻的大麻二醇（CBD）不再是受控物质。因此，大麻产品是 可用于大多数美国成年人。 66％的成年人认为大麻可以缓解疼痛，而42％ 药用大麻使用者报告使用它来减轻疼痛。最初的证据表明大麻 四氢大麻酚[THC]具有镇痛作用，这是与大麻相关的疼痛减少的证据 强度和干扰（即，疼痛干扰功能的程度）是有限的。有非常有限的 有关如何在法律市场上可用的各种大麻产品的影响（例如，不同的菌株， 交付方法）和使用模式影响疼痛结果和合并症（例如，心理健康，睡眠） 与疼痛有关的。作为华盛顿州的主权国家，我们的部落伙伴发展了 QWIBIL诊所，该诊所建议患者使用大麻治疗疼痛和其他医学 问题。 Qwibil诊所提供了一个独特的机会，可以调查大麻使用之间的关系， AIAN拥有和操作的诊所中的疼痛和与疼痛有关的因素。我们提出了嵌入的混合方法 （Quant+Qual）研究大麻如何影响n = 350的样本中的疼痛强度和干扰 在Qwibil诊所寻求慢性疼痛治疗的患者。我们将确定大麻使用的类型和模式 与超过12个月的疼痛结局有关。我们还将确定是否效果 大麻疼痛结局是通过已知的疼痛相关因素（即负面影响，睡眠问题， 自我效能）随着时间的流逝。为了补充我们的定量方法，我们将使用定性访谈来探索 寻求疼痛体验大麻及其对疼痛的影响的患者如何，包括不同的参与者 通过性别，种族（Aian，非亚洲人）和使用的大麻类型。最后，我们将为艾安提供机会 华盛顿州立大学医学，护理，药房和预防科学毕业生的学生 课程和西北印度学院的本科课程，以接受大麻的培训和指导 以及Qwibil诊所的疼痛研究，包括定性和定量数据收集的培训以及 研究结果的分析和传播。结果将提供有关影响的重要信息 大多数AIAS样本中的慢性疼痛的合法大麻产品，向患有的人提供重要信息 痛苦，提供者和部落决策者。